Category Archives: AMM 2013, Volume 59, Number 4

Genetics of Pain

DOI: 10.2478/amma-2013-0054

Pain is ”an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” [2]; it is a common problem, not only for patients, but also for the medical world.
Nociceptive pain has a protective role, a signal role, but if the lesions that caused it persist and are excessive, pain becomes a disease (neuropathic pain).
The partial failure of integrated treatment methods, especially in the case of chronic diseases, determined scientists to turn their attention towards the genetic conditioning of individual pain perception and the effectiveness or adverse reactions of painkillers or neuroleptic medication.
The financial aspect of treating pais is also of great importance: there are immense sums of money spent annually to treat pain: 150 billion USD in the USA, and 200 billion EUR in Europe [3]. Other pain-related aspects, such as depression (22%) and the loss of jobs (25%) also have to be considered [3].[More]

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Therapeutical Approach of Osteoporosis — a Multidisciplinary Issue

DOI: 10.2478/amma-2013-0053

Osteoporosis is the most frequent systemic disease of the bone, that affects elderly, mainly women in menopause. It can be defined by lowering of bone mass and microarchitectural deterioration of the bone tissue, resulting in an increased bone fragility. Main complications of osteoporosis are fractures of the vertebrae, hips and forearm. In view of its large variety of causes and manifestations, diagnostic and therapeutical approach in osteoporosis represents a multidisciplinary issue. The accurate diagnosis of osteoporosis is based on a method that measures the bone mineral density, expressed by the T-score, using dual energy X-ray absorptiometry, so called DXA. Lately, in practice in order for establishing the risk of osteoporosis and osteoporotic fracture the FRAX tool is increasingly used (The Fracture Risk Assessment). Treatment of osteoporosis is complex involving non-pharmacological and pharmacological measures. Non-pharmacological methods include preventive measures like exercise, external hip protectors, increase of dietary intake of calcium, vitamin D and proteins, especially in elderly, over 65 years. Pharmacological measures are represented by different types of drugs, including biphosphonates, bone formation stimulatory drugs, agents with new mechanisms of action, hormone replacement therapy and they will be indicated only after a detailed clinical and paraclinical examination of the patient. Regardless of the chosen pharmacological measure, periodical follow-up of efficacy, side-effects and complications of antiosteoporotic treatment, by clinical examination and laboratory investigations targeting bone remodelling, is strongly indicated.

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Quality Enhancement by Inclusion Complex Formation of Simvastatin Tablets

DOI: 10.2478/amma-2013-0052

Introduction: Simvastatin is an inhibitor of hydroxy-methyl-glutaryl-coenzyme A reductase, used in the treatment of hypercholesterolemia. To enhance its bioavailability by inclusion complexation, as host molecule randommethyl-β-cyclodextrin had been used. After evaluating the complexes we chose the kneading product in 1:2 molar ratio for incorporation of 10 mg simvastatin tablets.
Materials and methods: We prepared homogenous mixtures of the inclusion complex and some excipients. The tablets were prepared by direct compression. The tablets were evaluated in regard to: weight uniformity, thickness, diameter, hardness, friability, disintegration and dissolution profile.
Results: Weights are in the range of 196–208 mg, diameter 6.83–6.86 mm, height 3.86–4.01 mm, hardness 78.3–113.1 N, friability 0.75–1.19 %, disintegration above 15 minutes. The dissolved amounts of simvastatin from the tablets are higher compared to the dissolution of pure simvastatin, but lower than the dissolution of the complex itself. Excipients, like disintegrants and lubricants greatly influence the dissolution properties of the tablets.
Conclusions: According to our results, tablets containing inclusion complex of simvastatin exhibit better solubility, according to the dissolved amount of simvastatin, than pure drug alone. Proper physical parameters of the tablets are obtained by application of 5 % Primellose.

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A Comparative Study of Affective Bipolar Disorder with Schizoaffective Disorder from a Longitudinal Perspective

DOI: 10.2478/amma-2013-0051

Introduction: In the last years there is a great interest for the theory of the “psychotic continuum”, which accepts that there is a transition between schizophrenia and affective pathology, including bipolar disorder with psychotic interferences and the recently introduced diagnosis of schizoaffective disorder. There are few studies that analyze bipolar disorder with mood-incongruent psychosis. The purpose of this study was to observe the way in which the interference of mood-incongruent psychotic symptoms can influence the long term evolution of patients diagnosed with bipolar disorder and the similarities that exists between this type of pathology and schizoaffective disorder.
Material and methods: Sixty subjects were selected, who are now diagnosed with schizoaffective disorder and bipolar disorder, with and without psychotic features. All cases have at least 15 years of evolution since the first episode of psychosis and were analyzed in term of their age of onset and longitudinal evolution.
Results: The results showed that bipolar patients who had mood incongruent psychotic symptoms had an earlier age of onset and a higher rate of hospitalizations in their long term evolution compared to bipolar patients without psychotic features, which brings them closer to patients with schizoaffective disorder in term of their pattern of evolution.
Conclusions: This study has demonstrated that the interference of mood-incongruent psychosis with bipolar disorder determines a worse prognosis of this disease, very similar with the evolution of patients with schizoaffective disorder.

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Clinicians’ Choices in Selecting Orthodontic Archwires

DOI: 10.2478/amma-2013-0050

Objective: The aim of this study was to assess the choices made by clinicians in selecting archwires during the initial, intermediate and final stages of orthodontic treatment with fixed appliances.
Methods: We carried out a questionnaire-based study at the Orthodontics and Pedodontics Clinic Târgu Mureş, between March 2012 and September 2012. The questionnaires consisted of two parts: the first included questions related to the dimension, alloy used in fabrication, section (round or rectangular) and manufacturer of the archwires used by the orthodontists in their orthodontic practice, the second part was concerned with their personal opinion about the physical properties and disadvantages of the archwires.
Results: From a total number of 90 distributed questionnaires, 62 were returned. The majority of clinicians are using stainless steel (SS) and nickel-titanium alloy (NiTi) wires in their fixed orthodontic treatments, very few are using beta-titanium (Beta Ti), copper nickel-titanium (Co- NiTi) and esthetic archwires. The preferred dimension seem to be 0.022 inches in the appliance system. Regarding the wire dimensions, 0.014, 0.016 inch wires are mostly used from the round section group and 0.016 × 0.022 inch, 0.017 × 0.025 inch from the rectangular ones.
Conclusions: There is a general lack of agreement between the clinicians surveyed regarding the properties of an ideal archwire and the disadvantages of the used wires. The most frequently used alloys seemed to be the SS and NiTi.

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Herlant’s Tetrachrome Staining, a Useful Tool for Pituitary Adenoma Diagnosis

DOI: 10.2478/amma-2013-0049

Introduction: The morphologic diagnosis of pituitary adenomas (PA) is based on immunohistochemistry (IHC). In Romania, IHC diagnosis of PA is restricted, all of the specific antibodies being very expensive. A histochemical staining, Herlant’s tetrachrome (HTCS), was described several years ago, but it was not widely used for diagnostic purposes because of technical difficulties. The aim of this paper is to bring into discussion this staining, to highlight its benefits, to improve the technical procedures and to establish a protocol, which combining both HTCS and IHC, facilitates the diagnosis of PA and, especially, substantially reduces the costs.
Methods: HTCS was performed using normal pituitary glands. The optimal time of staining and the optimal concentration of different solutions were established for each step of the staining.
Results: The improved technical procedure of HTCS is described. The staining features of all cellular types of the pituitary gland are depicted and illustrated: the chromophore cells, GH-secreting cells stained in orange, PRL-secreting cells in red-violet and ACTH-cells in dark blue, while cromophobe cells stained light blue. These staining features can be extrapolated to the diagnosis of PAs, as they consist of a proliferation of such cells.
Conclusion: HTCS’s benefit is in functional PAs: it can identify GH, PRL, ACTH and TSH-adenomas, according to the cell type staining. A two-step diagnostic protocol is proposed, allowing the use of two, maximum three antibodies, instead of six: first step HTCS, and second step IHC.

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A Survey on the Methanol Content of Home Distilled Alcoholic Beverages in Transylvania (Romania)

DOI: 10.2478/amma-2013-0048

Objective: Methanol appears in relatively high concentrations in alcoholic beverages obtained from fermented fruits distillates. These products are traditionally home made in many regions in Romania and other EU countries. The chronic use of products with high methanol concentration can be considered a health risk. The purpose of this work was to measure methanol concentration in a Romanian region where brandy-type alcoholic products are made from different fruits (plum, apple, pear, grapes), and to observe if there is a type of product that contains more methanol than the others.
Methods: The content of methanol in the tested alcoholic beverages was determined using a gas chromatographic method.
Results: Only 18% of the tested 56 samples met UE regulation regarding methanol content of alcoholic beverages (0.4% in alcoholic drinks containing 40% ethanol). The highest concentration of 2.39% was found in a plum brandy. Plum brandies contained significantly higher amounts of methanol than brandies made from other fruits (0.91 vs 0.52%, p = 0.01).
Conclusions: Home distilled alcoholic beverages obtained from fruits are a health threat due to their high methanol content. Strict regulations and tests should be introduced for such products.

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Preliminary Results on Clinico-pathological and Immunohistochemical Features of Malignant Melanomas

DOI: 10.2478/amma-2013-0047

Objective: To perform a retrospective clinico-pathological and immunohistochemical analysis of malignant melanomas.
Methods: One-hundred sixty consecutive cases diagnosed in the Department of Pathology of the County Emergency Clinical Hospital of Tîrgu Mureş, Romania, between January 2000 – December 2009, were used. Of these, 47 cases were melanoma metastases that were excluded from the study; this research was focused on the study of 113 primary melanomas (PMs). In 20 cases of PMs (11 cutaneous, 5 choroidal, and 4 melanomas of the anal canal) immunohistochemical stains were performed using the antibodies p53, Ki67, ER (estrogen receptor), CD8 and CD31.
Results: Cutaneous PMs prevailed (83%) followed by choroidal (11%), digestive tract (4%) and nasal mucosa PMs (2%). Independent of their location, PMs predominantly affected females (58%) over age 50. Regarding cutaneous cases, lower limbs (49%) were more affected, followed by the head and neck (18%) and the trunk (18%). We noted negativity or low p53-nuclear positivity in cutaneous and digestive tract PMs; p53 was overexpressed in choroidal melanomas. On the other hand, although the proliferative index Ki67 was also quite low in cutaneous PMs, its percentage increased in choroidal and digestive tract PMs. CD8 was positive in cutaneous PMs and negative in choroidal and digestive tract cases. While in cutaneous PMs we noted a predominated angiogenesis by intussusception, in digestive tract melanomas there was a predominance of sprouting and pseudoglomeruloid mechanisms.
Conclusions: Choroidal PMs display the highest p53 and Ki-67 expression, compared to cutaneous MMs. Tumor angiogenesis seems to present a specific pathway in cutaneous PMS compared to the gastrointestinal cases.

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Prevalence and Drug Consumption Habits at the 2011 Peninsula Festival in Tîrgu Mureș

DOI: 10.2478/amma-2013-0046

Introduction: In 2010 Romania was ranked fourth in the European Union regarding the prevalence of ethnobotanical drug use with psychotropic effect. The main purpose of our survey was to collect data on substance use and assess drug consumption habits among participants at the 2011 Peninsula Music Festival in Tîrgu Mureș, Romania.
Material and method: The study was carried out as a cross-sectional survey in a sample of 256 persons, using an anonymous, self-administered structured questionnaire, containing questions about the consumption patterns of illegal psychoactive drugs, as well as sociodemographic data which could influence drug consumption (age, gender, educational level, marital status of parents).
Results: Ethnobotanical drug consumption had the highest lifetime prevalence (37.7%), the second most often used drug was cannabis (marijuana) with a lifetime prevalence of 35.2%. Males and females differed significantly in the use of marijuana (p = 0.023) and ethnobotanical drugs (p = 0.008) in the last 12 months, male respondents used more of these psychoactive substances. In the case of children with divorced parents the last 12 months marijuana use (p = 0.032) and ethnobotanical drug use (p = 0.013) was significantly higher than in the case of children whose parents were not divorced.
Conclusions: The survey results show the importance of the development of health education programs and drug-prevention strategies for vulnerable goups (festival visitors, minors, children with divorced parents).

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The Characteristics of Amiodarone-induced Thyrotoxicosis in a Moderate Iodine Deficit Area

DOI: 10.2478/amma-2013-0045

Introduction: Amiodarone (AMI), a class III anti-arrhythmic drug, is associated with a number of side effects, including thyroid dysfunction (both hypo- and hyperthyroidism), which is due to amiodarone’s high iodine content and its direct toxic effect on the thyroid.
Objective: To evaluate the incidence of Amiodarone induced thyrotoxicosis (AIT) (type, rate of occurrence) and to identify the risk factors involved in its occurrence.
Material and method: We examined patients treated with amiodarone, between January 2002 and December 2011, who presented to our Department of Endocrinology Târgu Mures for thyroid dysfunctions.
Results: The retrospective study included 87 patients with thyroid dysfunctions; 58 (66.7%) patients had AIT and 29 (33.3%) had Amiodarone induced hypothyroidism (AIH). In the AIT group: 35 were women (60.3%), 23 were men (39.7%); the average age was 61.60 ± 12.39 years. Risk factors identified for the AIT group were male gender (RR = OR = 3.8; Chi-squer = 5.7, p = 0.004) and pre-existing thyroid abnormalities (RR = 2.5, Chi-square = 4.1, p = 0.005). The thyroid dysfunction occurrence was heterogeneous (0.2–183 months). The patients with previous thyroid abnormalities developed earlier thyroid dysfunction compared to those with an apparently normal thyroid gland (22.25 ± 4.14 months versus 32.09 ± 7.69 months, p = 0.02, T test).
Conclusion: In the context of the specific iodine geoclimatic intake and the area of origin, amiodarone – induced thyroid dysfunction spectrum is dominated by thyrotoxicosis. Screening and monitoring of thyroid function for patiens under chronic amiodarone treatment is necessary.

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